Matrix effect on baked milk tolerance in children with IgE cow milk allergy

Background: Children with IgE-mediated cow’s milk allergy (IgE-CMA) often tolerate baked milkwithin a wheat matrix. In our study we evaluated the impact of wheat matrix and of littlestandardised cooking procedures on tolerance of baked milk. We also tested tolerance versusparmigiano reggiano (PR) and whey-based partially hydrolysed formula (pHF).Methods: Forty-eight children with IgE-CMA were enrolled. They underwent prick-by-prick(PbP) and open oral food challenge (OFC) with baked cow’s milk (CM), both within a wheatmatrix (an Italian cake named ciambellone) and without (in a liquid form), with PR and withpHF. After a passed OFC, children continued to eat the food tolerated. In particular, afterpassed OFC with ciambellone, children were allowed to eat any food containing CM within awheat matrix, with the only condition that it was baked at 180◦C for at least 30 min. Threemonths after, parents were asked to answer a survey.Results: 81% of children tolerated ciambellone, 56% liquid baked CM, 78% PR and 82% pHF. Neg-ative predictive value of PbP performed with tested foods was 100%. No IgE-mediated adversereactions were detected at follow-up carried out by the survey.Conclusions: Wheat matrix effect on tolerance of baked milk was relevant in slightly less thanhalf of cases. If our results are confirmed by larger studies, a negative PbP will allow patients toeat processed CM without undergoing OFC. Moreover, in order to guarantee tolerance towardsbaked milk, strict standardised cooking procedures do not seem to be necessary.© 2016 SEICAP. Published by Elsevier Espa˜na, S.L.U. All rights reserved.